ACA EVP Weekly Report

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Posted March 3, 2003

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Posted March 3, 2003

ACA EVP Weekly Report

Memorandum

ACA Members, Board of Governors, House of Delegates and Other Interested Parties From: Cuneo Re: ACA EVP Weekly Report Date: March 3, 2003

Not only has the terrorist threat level been lowered, the expected 40-degree temperatures mean no more snow in the D.C.-area! But there are other great reasons to attend this week's National Chiropractic Legislative Conference (NCLC) as well, including:

· Appearances by two members of President Bush's cabinet. · A political workshop including both the RNC's Director of Grassroots Development and the chairperson of the DNC's Women's Leadership Forum. Sparks will undoubtedly fly!

· Chairman's Club Lunch featuring Congressman Bill Janklow (R-SD). This former South Dakota governor signed numerous chiropractic bills is now the only Congressman from South Dakota

· COCSA-sponsored roundtable discussion. Topics covered will include Hospital Relations; HIPAA; Spinal Manipulation Protection Legislation and an Open Forum. Experts will lead discussions on each topic.

Call the ACA at 800-986-4636 for more details.

The following topics are covered in this week's report:

1. MANAGED CARE INDUSTRY SCREAMS OVER RECENT APPELLATE COURT DECISION 2. ACA RECEIVES WRITTEN CONFIRMATION OF EXPANDED COVERAGE UNDER THE FEDERAL BLUE CROSS/BLUE SHIELD PLAN 3. ASHN WARNS OREGON DOCTORS OF ANTITRUST CONSEQUENCES 4. SACA OFFICERS VISIT NATIONAL BOARD 5. MORE INFORMATION REGARDING MEDICARE PAYMENTS 6. HOUSE REPUBLICAN LEADER PRESENTS AGENDA FOR NEXT SIX MONTHS 7. ACA BRINGS ATTENTION TO MONTANA BLUE CROSS/BLUE SHIELD PROBLEMS 8. JACA COVERS 3RD INTERNATIONAL CONFERENCE ON VACCINATIONS 9. NCLC TO FEATURE AN IMPRESSIVE ARRAY OF CORPORATE SPONSORS 10. CAN'T ACCESS THESE LINKS?

1. MANAGED CARE INDUSTRY SCREAMS OVER RECENT APPELLATE COURT DECISION

In what some in the managed care industry are claiming will be the end of their business, the influential 2nd Circuit U.S. Court of Appeals overturned a lower court decision and made a significant shift in the way they view the ERISA preemption rule. The case, titled Cicio vs. Vytra Health Care, which was decided on Feb. 17th, concerned an HMO that denied the treatment of a cancer patient as recommended by the doctor. The patient died and the family sued. The HMO claimed that its ERISA status exempted it from state and local law. In overturning the lower court decision, the court cited a recent U.S. Supreme Court decision in stating that the HMO could in fact be held to the state law.

2. ACA RECEIVES WRITTEN CONFIRMATION OF EXPANDED COVERAGE UNDER THE FEDERAL BLUE CROSS/BLUE SHIELD PLAN

As I previously reported to you, the ACA was seeking specific written confirmation of an expansion of coverage in the federal BC/BS employee health benefit plan. I am happy to report that we have received such confirmation in a letter dated February 13, 2003 from the U.S. Office of Personnel Management. The agency has confirmed to ACA's attorney that chiropractors may now receive reimbursement for covered physical therapy services if such services are authorized under that doctor of chiropractic's state license. We are in the process of communicating this determination to the national Blue Cross/Blue Shield Association, the administrator of the federal plan. The coverage applies both to the Standard Option and also to the Basic Option (if the doctor is a "preferred provider: under the Basic option). All of this is a direct result of our settlement with BC/BSA in the Trigon litigation. That settlement included a first-time chiropractic manipulation benefit in the Basic Option and now has also resulted in the expansion of coverage under both options. Please contact ACA's legal department for more details on this new coverage.

3. ASHN WARNS OREGON DOCTORS OF ANTITRUST CONSEQUENCES

In a rather remarkable memo provided to us by an Oregon ACA member, ASHN writes to all "Participating Providers" informing them that ASHN is "excited as our business is growing and expanding in 2003," but then states, "We also would like to discuss a matter of some concern to ASH Networks and, we believe, to all of our chiropractors." The memo goes on to state that, "We have learned that some Oregon chiropractors attended a meeting on February 2, 2003 at

Western States Chiropractic College where one of the topics discussed, and possibly advocated, was a large-scale resignation from ASH Networks." The memo then details the dire antitrust consequences involved in such activity and warns in a rather ominous tone that, "We encourage you to consider any actions you may take in response to this recent meeting with great care."

While this type of warning directed to those ASHN refers to as "our chiropractors" may seem in our view offensive and even insulting, it nevertheless reflects the current state of the law. That is why ACA has pressed so hard in Congress to reform the federal antitrust laws. We believe that chiropractors and other health care providers should be able to come together to discuss common problems and to take collective action in connection with the negotiation of managed care agreements.

In our opinion, the playing field is not level and managed care and insurance companies can often dictate terms with no meaningful way for the individual doctor to respond. This is an excellent example of why your support of ACA and its legislative actions is so critical to your future.

4. SACA OFFICERS VISIT NATIONAL BOARD

In January, Student ACA (SACA) national officers visited the National Board of Chiropractic Examiners (NBCE) offices in Greeley, Colorado, to meet with staff and NBCE officers and to discuss examination procedures. ACA leaders included: Janelle Whitehead, SACA National Chair; Mayeda, SACA National Vice Chair; Skow, SACA National Legislative Chair; and Caitlin roe, National Vice Legislative Chair.

The NBCE was represented by Dr. Hideg, NBCE Chairman, and Dr. Ferguson, NBCE President. The day-long visit provided the SACA leaders with a good understanding of the process followed by the NBCE in the development and administration of the written and practical examinations, as well as the methods used in scoring exams. At the end of the day there was a panel discussion during which the SACA leaders were able to ask NBCE leaders questions of concern to students.

Janelle has prepared an interesting report of the meeting and was interviewed by ACA Today. The interview will be in the March eSACA Today and the May issue of ACA Today. Keep an eye out for it--it's really good.

5. MORE INFORMATION REGARDING MEDICARE PAYMENTS

As I reported to you last week, on February 20th, President Bush signed into law the Fiscal Year 2003 omnibus appropriations bill which included a correction of the Medicare physician payment formula. Rather than the 4.4% cut in reimbursement that had been feared, the legislation provides for a 1.6% reimbursement increase effective March 1, 2003. Under the final rule published by CMS today, all physicians and practitioners now have until April 14, 2003, to make their 2003 Medicare participation decision.

After March 1, doctors will continue to be paid at the previous rates, but an adjustment will be made after July 1 to recapture the underpayments. CMS has an excellent Q/A on their web site that provides additional information:

MS Q & A -- <http://www.cms.gov/regulations/pfs/fr2003qa.pdf>

CMS Fact Sheet -- <http://www.cms.gov/media/press/release.asp?Counter=712>

Medicare Physician Fee Schedule for 2003 Final Rule (Federal Register) -- <http://www.cms.gov/providerupdate/regs/cms1204f2.pdf>

CMS Program Memorandum, Intermediaries/rs (Implementing Instructions) -- <http://www.cms.gov/manuals/pm_trans/ab03027.pdf>

6. HOUSE REPUBLICAN LEADER PRESENTS AGENDA FOR NEXT SIX MONTHS

Last week, House Majority Leader Tom DeLay (R-TX) told GOP members that the House is entering the "toughest seven weeks of the year" and "longest sustained legislative heavy lifting for the year." He pledged prompt action on:

· Fiscal Year 2004 budget resolution and debt limit increase · Tax-cut package · Human cloning ban · Medical liability reform (Energy and Commerce mark-up next week and on floor by 3/10) with a medical errors bill aimed at avoiding situations like last week's organ transplant fiasco at Duke University

DeLay added that leadership is beginning to work on a Medicare prescription drug plan. Bingo! Here is one opportunity to include our chiropractic provision.

7. ACA BRINGS ATTENTION TO MONTANA BLUE CROSS/BLUE SHIELD PROBLEMS

Following is an update on the ACA's BC/BS Chiropractic Clinical Healthplan Integration Program-better known as Blue CCHIP. The program aims to bring doctors of chiropractic together with representatives from their local Blue Cross/Blue Shield plans to resolve access and reimbursement issues.

After a series of disappointing talks earlier this year between the Montana Chiropractic Association, the state Blue CCHIP liaison Dr. Lee Hudson and the local Blue Cross Blue Shield plan, the ACA stepped into the discussions to address the problem at hand: a capped benefit on chiropractic services and other unfair practices.

Representing ACA at the Feb. 13 meeting with the Montana Blues' medical director and legal counsel were: Dr. Combs of the ACA board of governors; Tom Daly, ACA legal counsel; , ACA vice president of professional development and research; and Dr. Lee Hudson, Blue CCHIP representative. Dr. Greg Pisk and Dr. Sando, incoming president of the Montana Chiropractic Association, also participated. The meeting was intended to reopen communications that would focus on the problems Montana DCs experience and to bring to light the implications of the ACA's lawsuit against Trigon (Anthem) Blue Cross/Blue Shield in Virginia--which is based on similar practices that appear to be taking place at the Montana Blues.

ACA's message is clear, says Dr. Combs: "We are not going to back away from a set of discriminatory practices that do not allow doctors of chiropractic the right to treat patients within a quality framework and to receive fair market value for their services." ACA expects negotiations with the Montana Blues to be ongoing. The ACA will push for equal treatment for chiropractic services, says Dr. Combs, who adds that nationally, DC services represent only .26 percent of all health care spending across the nation.

8. JACA COVERS 3RD INTERNATIONAL CONFERENCE ON VACCINATIONS

A February 2003 article in the Journal of the American Chiropractic Association (JACA) covers the 3rd International Conference on Vaccinations that was held in Washington, D.C. on Nov. 7-9, 2002 by the National Vaccine Information Center (NVIC)--a national, non-profit educational organization, advocating vaccine safety research and patients' informed consent.

Written by ACA's Associate Director of Production Nataliya Schetchikova, PhD, the JACA article was featured in a recent news bulletin, prompting interested doctors of chiropractic and patients to call ACA for copies of the article. The article features experts on vaccination-related issues and points out that the dramatic growth of chronic diseases in the U.S. may be attributed to reactions to the increasing number of vaccinations children now receive. The topics covered include the vaccination connection with autism, asthma and cancer, autism research and treatment, and issues surrounding hepatitis B, flu and smallpox vaccines.

Visit ACA's Web site at <http://www.acatoday.com/media/releases/nvic.shtml> for a copy of the news bulletin, as well as a copy of the article, "Truth in Science: the Right to Know and the Freedom to Decide," from the February 2003 issue of JACA.

9. NCLC TO FEATURE AN IMPRESSIVE ARRAY OF CORPORATE SPONSORS

More sponsors than ever are supporting the 2003 National Chiropractic Legislative Conference. ACA thanks:

· The Platinum Sponsor--Ekornes (www.ekornes.com <http://www.ekornes.com>); · Gold Sponsors--Breakthrough Coaching (www.mybreakthrough.com <http://www.mybreakthrough.com>), Scrip (www.scrip.com <http://www.scrip.com>), Springwall (www.springwall.com <http://www.springwall.com>), and Antioxidant Health Group (www.myantioxidanthealth.com <http://www.myantioxidanthealth.com>)

· Silver Sponsors--Samsonite/Chiropak (www.samsonitecompanystores.com <http://www.samsonitecompanystores.com>), Performance Health (www.biofreeze.com), Foot Levelers(www.footlevelers.com <http://www.footlevelers.com>) and Shekel Electronic Scales (www.shekelscales.com <http://www.shekelscales.com>);

· And sponsor of the SACA Dinner, PassYourBoards.com (www.passyourboards.com <http://www.passyourboards.com>)

10. CAN'T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com/>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>.

************************ This message is being sent to you as a courtesy by the executive vice president of the American Chiropractic Association. If you wish to be removed from this list, simply send a message to kpark@... <mailto:kpark@...> with a subject of: "REMOVE - EVP Report."

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Posted March 26, 2003

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Posted March 26, 2003

ACA EVP Weekly Report

MEMORANDUM ACA Members, Board of Governors, House of Delegates and Other Interested Parties From: Cuneo Re: ACA EVP Weekly Report Date: March 24, 2003

The following items are included in this week's report:

1. LEGAL ARGUMENTS NOW AVAILABLE TO DOCTORS OF CHIROPRACTIC 2. ACA WEB SITE NOW HOSTS NATIONAL 'FIND A DOCTOR OF CHIROPRACTIC' SEARCH FEATURE 3. PROGRESS IN IMPLEMENTING CHIROPRACTIC DOD LEGISLATION 4. CAC MEETING AT NCLC WAS A SUCCESS 5. HOD ADOPTS DISASTER PROTOCOLS: INFORMATION REQUESTED 6. SPECIAL LEGISLATIVE AWARDS 7. PUBLIC SERVICE ANNOUNCEMENT FEATURING DEREK PARRA, GOLD AND SILVER MEDAL WINNER, IS WORTH CONSIDERING 8. CAN'T ACCESS THESE LINKS?

1. LEGAL ARGUMENTS NOW AVAILABLE TO DOCTORS OF CHIROPRACTIC

Last year, during a contested hearing before Judge in our lawsuit against Trigon Blue Cross/Blue Shield, ACA attorney Mcs presented a brief that included citations from a number of medical publications that reaffirmed our position that chiropractic care is superior in the treatment of neuromusculoskeletal conditions. He quoted from numerous medical and government sources in making this point. Included in the brief were citations from the ls of Internal Medicine, Rand, the Journal of Bone and Joint Surgery, Duke University, the AHCPR guidelines, various workers' compensation studies and more.

In response, Judge commented that:

(1) Interrogatory ten quotes from nine studies purporting to show that doctors of chiropractic are more effective and have more training than medical doctors in treating the musculoskeletal system. The interrogatory then asks Trigon, in light of these studies, to provide any studies or information that it relied upon in making its decision to pay doctors of chiropractic differently than medical doctors for the same services performed.

(2) Interrogatory '9(' requires Trigon to disclose any study "and/or other information" supporting greater payments to medical doctors than to doctors of chiropractic. The answer to that interrogatory ought to supply the plaintiffs with any relevant information needed to prevent surprise in the preparation of the case for trial, particularly in conjunction with other discovery methods that the plaintiffs may utilize.

Trigon failed to provide any contrary study. Instead it chose to rely on the greater expense of education for medical doctors over that spent by chiropractors to justify its discriminatory actions.

Mr. Mcs has put together many of the quotations from the publicly available literature into a single, 11x17 colored promotional piece that lays out the best argument for chiropractic care. He strongly urges that each doctor make hundreds or even thousands of colored copies of the document and circulate it far and wide to, for example:

insurance carriers hospitals unions businesses golf courses community centers health clubs social clubs tennis and racquetball clubs bulletin boards legislators office handouts or mailers fold-ins for newspapers schools sports teams Olympic committees editors professional associations teachers nurses military personnel churches medical doctors editorial and column writers chambers of commerce.

Ever the patriot, Mcs even suggested that we should ask the Department of Defense for permission to drop them as leaflets over Baghdad. What better way to promote the positives of the profession than by quoting extremely reputable sources that aren't even chiropractic?

Called the "Spokes of Chiropractic Progress," we urge that you take advantage of this opportunity to promote chiropractic. An introduction to the Spokes, as well as instructions on downloading the document, can be found on ACA's web site at: <http://www.acatoday.com/legal/spokes.shtml>.

How to download and print the document:

Click on the link below to download this PDF file to your computer. Then save it to a disk and take it to your local copy center to have it printed out and copied. The reason this method is necessary is that the document is size 11x17, which most personal printers cannot handle. <http://www.acatoday.com/pdf/SpokesofChress011403.pdf>

2. ACA WEB SITE NOW HOSTS NATIONAL 'FIND A DOCTOR OF CHIROPRACTIC' SEARCH FEATURE

Any consumer can now search to find an ACA member doctor of chiropractic in their local community using our award-winning web site. Visit <http://www.acatoday.com/search/memsearch.cfm> and enter a zip code, city, chiropractic specialty, last name, or any combination to search for a member in your area.

3. PROGRESS IN IMPLEMENTING CHIROPRACTIC DOD LEGISLATION

One year after the implementation of the DOD legislation, we have some good news and some not so good news. The good news is the number of bases where chiropractic is offered has nearly doubled. The Navy continues to push the implementation of chiropractic into their service. Bethesda Naval Hospital is very supportive of chiropractic and doesn't hesitate to promote its availability to its Navy personnel. Navy physicians in charge at Bethesda have publicly indicated their strong support for the chiropractic program, as it has exceeded even their wildest predictions. DOD has indicated that we will be considered for commissioning. And the Coast Guard, while not affected by the legislation, has reached out on its own in attempting to include the chiropractic benefit.

The Army, however, is a different story. If you were to go to Walter Hospital in Washington, D.C., you would be hard-pressed to find the word chiropractic anywhere. There is no effort to promote the profession. We understand through the grapevine that some of the brass might be saying that now that Senator Thurmond is gone, there will be nobody there to protect chiropractic. I sure hope their judgment is better than this when it comes to fighting Iraq.

Our DOD Advisory Committee has not had a meeting with the DOD in some time. They sent a letter to DOD expressing concerns about a number of issues that weren't being addressed. The type of response we receive will determine whether we need to go back to the legislature. We have briefed members of Congress regarding the possibility.

The legislation called for the implementation of the chiropractic benefit in the armed services within five years. We will continue to push this deadline and attempt to get chiropractic fully implemented even more quickly.

4. CAC MEETING AT NCLC WAS A SUCCESS

On Friday, March 7, 2003, during the ACA's National Chiropractic Legislative Conference (NCLC) held at the Hyatt Regency Hotel in Washington D.C., a workshop meeting was held for chiropractic r Advisory Committee (CAC) representatives from across the country.

The highlight of the meeting was a presentation by Lawlor, DC, MBA, Senior Outreach Specialist for the Centers for Medicare and Medicaid Services (CMS). Dr. Lawlor, the first chiropractic physician appointed to a position within CMS, gave an interesting report about his chiropractic background, his job description, and his experience with CMS thus far. He will undoubtedly be a great representative for the chiropractic profession within CMS!

Joe , DC, who serves on the Practicing Physicians Advisory Council (PPAC), gave a presentation about what role this council plays in determining Medicare/Medicaid policies and the significance of having a chiropractic physician on this council.

Ritch , DC, Chairman of the ACA Medicare Committee, and McClelland, BS, CCA, ACA Medicare Committee member, spoke of the importance of the CAC representative to each state and to the nation. They also addressed the importance of required documentation, as well as the need to appeal denials.

5. HOD ADOPTS DISASTER RELIEF PROTOCOLS: INFORMATION REQUESTED

The ACA House of Delegates has passed a recommended protocol for chiropractic doctors who wish to serve in disaster situations. ACA will be distributing this information to all states, councils and colleges along with potential sources of disaster education. If you, your state, college or specialty council offers training in any form related to disasters, first aid, emergency or if you are aware of public sources of training (state, Internet or organizations), please contact Bernat at the ACA with the information at: pbernat@... <mailto:pbernat@...>.

6. SPECIAL LEGISLATIVE AWARDS

Chiropractic has many friends in Congress and within the administration. Each year at NCLC we recognize some of these friends. Here is a list of prominent leaders who we recognized this year:

Health and Human Services Secretary Tommy -- recognized for his visionary leadership on the health care challenges facing America, steadfast support for chiropractic care, including through his department's development of a pilot program to allow doctors of chiropractic to participate in the National Health Service Corps student loan re-payment program, and for maintaining an open door tothe ACA throughout his tenure as the nation's top health policy official.

Rep. Tauzin (R-LA) -- recognized for his enlightened understanding of the benefits of chiropractic care, his active support for legislation to allow doctors of chiropractic to participate in the National Health Service Corps student loan repayment program and his leadership as chairman of a key House committee on expanding access to chiropractic care.

Rep. Steve Buyer (R-IN) -- recognized for his outstanding leadership of the House Veterans Affairs Committee's Subcommittee on Health, and his successful efforts to enact and support implementation of legislation to provide a chiropractic care benefit for America's active duty military personnel and veterans.

Rep. Bob Filner (D-CA) -- recognized for being a leading friend in Congress of the chiropractic profession and an effective supporter of legislation creating a chiropractic care benefit for America's veterans.

White, Legislative Director, Office of Rep. Tauzin (R-LA) - for being a friend of the ACA and doctors of chiropractic in the State of Louisiana, and for leadership efforts at the staff level to enact legislation allowing doctors of chiropractic to participate in the NationalHealth Service Corps student loan repayment program.

Adam Gluck, Legislative Assistant, Office of Sen. Tom Harkin (D-IA) - for being a friend of the ACA and doctors of chiropractic in the State of Iowa, and for leadership efforts at the staff level to enact legislation to establish a chiropractic benefit for America's veterans and allow doctors of chiropractic to participate in the National Health Service Corps student loan repayment program.

Veterans Affairs Secretary Principi -- recognized for his years of distinguished military and public service, leadership in strengthening the veterans health care system and creation of a special advisory committee within the Department of Veterans Affairs that is now developing a plan to provide America's veterans with the chiropractic care they need and deserve.

7. ACA PUBLIC SERVICE ANNOUNCEMENT FEATURING DEREK PARRA -- GOLD AND SILVER MEDAL WINNER -- IS WORTH CONSIDERING

ACA has worked with Olympic speedskater Parra, who won both a gold and silver metal at the 2002 Winter Olympics to tout the benefits of chiropractic care in a professionally produced Public Service Announcement (PSA) and television ad spot. PSAs are a highly effective way for individuals or non-profit organizations to reach a large audience. PSAs help to raise funds, increase public awareness of an issue or trend, make a call to action, or change attitudes or perception.

Included with both the PSAs and the ad spot are tips on how to place them on your local television or cable system. To view samples of the ad spots and the PSAs, visit ACA's web site at <http://acatoday.com/media/related/070102.shtml>. You will need to download Windows Media Player at <http://www.microsoft.com/windows/windowsmedia/download>.

PSA (one tape includes a 15, 30 and 60-second version) -- $90 60-second TV ad spot (as-is, non personalized) -- $290 60 TV ad spot (customized with your clinic info) --$536

To order your ad spot or PSA, call 800-368-3083.

8. CAN'T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com/>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>.

************************ This message is being sent to you as a courtesy by the executive vice president of the American Chiropractic Association. If you wish to be removed from this list, simply send a message to kpark@... <mailto:kpark@...> with a subject of: "REMOVE - EVP Report."

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Posted April 2, 2003

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Posted April 2, 2003

ACA EVP Weekly Report

Memorandum

ACA Members, House of Delegates, Board of Governors and Other Interested Parties From: Garrett Cuneo Re: ACA EVP Weekly Report Date: March 31, 2003

This week's report includes the following items:

1. THIRD MEETING OF THE VETERANS AFFAIRS CHIROPRACTIC ADVISORY COMMITTEE MORE SIGNIFICANT THAN INITIAL TWO 2. VA UNDER SECRETARY MAKES SURPRISE VISIT 3. PASSING OF EDWARD MAURER, DC 4. LAWSUIT UPDATE 5. MEMBERS AND NON-MEMBERS CONTINUE TO SUPPORT THE LAWSUITS 6. SUPPORT FROM MANY SECTORS FUELS THE LEGAL ACTION FUND 7. OHIO DOCTORS TO HOST CONTINUING EDUCATION SEMINAR; McANDREWS TO MAKE APPEARANCE 8. WORLD FEDERATION OF CHIROPRACTIC'S 7TH BIENNIAL CONGRESS 9. REVISED MEDICARE MANUAL AVAILABLE 10. PARKER SEMINARS BRINGS TO DALLAS AN "EVENING OF PHILOSOPHY" BY DR. JOHN DEMARTINI 11. CAN'T ACCESS THESE LINKS?

1. THIRD MEETING OF THE VETERANS AFFAIRS CHIROPRACTIC ADVISORY COMMITTEE MORE SIGNIFICANT THAN INITIAL TWO

Along with members of ACA's Government Relations staff, I attended portions of the Veterans Affairs (VA) meeting held in Washington, D.C., on March 25th and 26th. This was a particularly important meeting as the committee was asked to review the first draft of the document which would eventually become part of the recommendations to the Secretary of Veterans Affairs on implementing chiropractic into the VA health system. The draft included the tough issues of scope of practice and access. There was a lot nitpicking on the document, particularly by the non-DC members of the committee, with much discussion about the access problem in particular. I think access is the real sticking point. The VA system is set up as a referral system of health care with PHP being the dominant player. We are basically asking the VA to set up a different protocol to compensate for the bias that exists among the VA medical physicians. The good news is there appears to be a real understanding by all or nearly all of the committee members that a bias or at a minimum at lack of understanding exists with the medical doctors in the system and that something needs to be done to ensure that the prescribed intent of giving veterans access to chiropractic is fulfilled. Public testimony was offered at this meeting and the following individuals and organizations presented: , DC, ACA Chairman; Mr. O'bryon, representing the Association of Chiropractic Colleges; Wayne Wolfson, DC, representing the Federation of Chiropractic Licensing Boards; McCoy, DC, representing the World Chiropractic Alliance; Mr. Chapman-, representing the World Federation of Chiropractic; McClelland, DC, representing the Foundation for Chiropractic Education and Research; and Mr. Hendrickson, representing the International Chiropractors Association.

Dr. attended both days of the meeting and prepared a detailed report on it. Its worth reading. The report can found at: <http://www.acatoday.com/government/va/032803.shtml>

2. VA UNDER SECRETARY MAKES SURPRISE VISIT

To the surprise of everyone including the staff of the Department of Veterans Affairs, Dr. Roswell, Under Secretary for Health of the VA came to the committee hearing and made a presentation. In a fairly frank and direct manner, he expressed the department's view on the implementation of chiropractic in the VA system. He started by indicating that he didn't believe that chiropractors were primary care providers. However, he believes that we would be an important part of the VA health care team by providing a holistic approach to health care that would improve patient satisfaction, reduce pain and reduce the need for medication. He challenged the committee to think outside of the box as it attempts to bring this profession into the VA system. While we may not like his comments about primary care, the rest of his remarks were encouraging, particularly as they came from the third-highest ranking officer in the department. And they were consistent with the frank remarks made by Secretary Principi at our National Chiropractic Legislative Conference (NCLC) two weeks ago.

While it's too early to declare victory, you do get a sense that at least the Secretary and his high- level staff are going into this process without the biases of past administrations, and that maybe the interests of the veterans will be given priority.

Next week we will have the video of Secretary Principi's speech at NCLC, along with video of the comments made by HHS Secretary Tommy and others, available for viewing on our Web site.

3. PASSING OF EDWARD MAURER, DC

It is with deep regret that I report the passing of Dr. Ed Maurer last Friday morning at his home in Michigan. Ed did so many great things for this profession. He served faithfully as a member of ACA's Board of Governors, including service as ACA Chairman from 1997 to 1999. He was fair and principled, and was always supportive of the staff. Recently, he was one of the principals on the JACA Editorial Review Committee and had a major influence on the new direction of the magazine. In 2001, he was named ACA's "Doctor of the Year" and recently received a "Chairman's Award" at NCLC. ACA Chairman Dr and I traveled to Kalamazoo to represent the ACA at his funeral on Tuesday. Also there to show their respect were Dr Kerwin Winkler, past Chairman of the BOG; Dr Reeve Askew, past 3rd member of the Executive Committee: Dr Phil Knight, delegate from Michigan; Dr Jim Rehberger, delegate from Illinois South; Dr Parry from Logan College and Dr We will miss him.

Contributions in Dr. Maurer's memory can be made to the Maurer, DC Memorial Scholarship Fund at 2330 Gull Rd.,Kalamazoo, Michigan 49048.

4. LAWSUIT UPDATE

There is no breaking news to report at this time on either one of our lawsuits, as neither judge has ruled on motions for summary judgments that have been presented. As we await these decisions, we recognize that regardless of outcome, either side will appeal the decisions. As we've stated before, we are in this thing for the long haul.

5. MEMBERS AND NON-MEMBERS CONTINUE TO SUPPORT THE LAWSUITS

I am happy to report that March has become the largest single month for contributions in National Chiropractic Legal Action Fund (NCLAF) fundraising history. Total funds raised as of March 25 are $335,000, with nearly a week remaining in the month. This brings the total raised over the last 6 months to $1,175,000, which is close to the 12-month total of $1,357,000 raised in all of fiscal year 2002. This significant increase in contributions is due in large part to the continuing support of our monthly contributors. In the last year, the number of monthly contributors has risen from 269 in March 2002 to over 900 at present. Our goal is to increase the number of monthly contributors to 2000.

We must maintain our funding level in order to deal with our deep-pocketed adversaries. We know the court battles and appeals that lie ahead will be costly, and we want to be sure the resources are there to help secure a successful outcome.

6. SUPPORT FROM MANY SECTORS FUELS THE LEGAL ACTION FUND

Our successes at -Las Vegas in January and at NCLC in March, plus our monthly contributors, have gone a long way in helping us increase our legal action fund. But it's also the efforts of individual doctors on the state level that are helping the cause. I'd like to highlight this week the efforts made by doctors in Nebraska, Iowa and Illinois.

Dr. Ritch reported another successful fundraising effort at the Nebraska Chiropractic Physicians Association convention. They brought in nine additional monthly contributors plus cash. Let's look at what Nebraska has done since 1998: 98 doctors from Nebraska have contributed or are currently contributing. The total from individual doctors is $104,804. In addition, the state association has contributed $55,001. Not bad for a state with only 250+ doctors!

Dr. Dow Bates, ACA delegate to Iowa, also reported on his success at the recent Iowa Chiropractic Society conference. He received $5,200 in cash and pledges. Doctors in Iowa have been terrific, raising a total of $70,378, including $3,500 from the Iowa Chiropractic Society itself, $1,000 from the Iowa Society of Chiropractic Orthopedics, $500 from the Northwest Iowa Chiropractic Society and $100 the Southwest Iowa Chiropractic Society.

Finally, Dr. Zange, ACA Governor (District 2) did her usual fine work at the Illinois Chiropractic Society meeting last weekend. In addition to providing coverage for the ACA booth and selling ACA products, she also raised over $2,800 in pledges and cash. Illinois doctors and associations have contributed a total of $156,636.60, including $4,000 from the Illinois Chiropractic Society, $4,500 from the Central Illinois Chiropractic Society, $3,600 from the Northern Illinois Chiropractic Society, and $1,800 from the Chicago Chiropractic Society.

7. OHIO DOCTORS TO HOST CONTINUING EDUCATION SEMINAR; McANDREWS TO MAKE APPEARANCE

The doctors from the Northeast Ohio district of the Ohio State Chiropractic Association, which includes Cleveland, Youngstown, Canton and Akron, are hosting a continuing education seminar on April 12-13 at the Kent State University Convention Center in Canton, Ohio, where a portion of the funding will go to the National Chiropractic Legal Action Fund. The program will be a great "meat and potatoes" seminar that will give doctors of chiropractic useful information to help them survive and thrive in practice beginning Monday morning. It will teach them how to fight back professionally in a system that is stacked against them and their patients (workers' comp, PI, claim review response, ERISA, URAC, documentation issues and more). It's a pretty good fit with rallying the chiropractic troops around our national 'Simple Justice' legal efforts. In addition to an array of expert speakers, Mr. Mcs will be present to provide an update on the lawsuits.

If you would like further information, please contact either Dr. Judson Sprandel (330-455-4602; BLUECRUS@... <mailto:BLUECRUS@...>) or Dr. Tim Weir (330-452-4040; weirdc@... <mailto:weirdc@...>).

8. WORLD FEDERATION OF CHIROPRACTIC'S 7TH BIENNIAL CONGRESS

ACA and the Foundation for Chiropractic Education and Research, along with other groups, are proud to co-sponsor the World Federation of Chiropractic's (WFC) 7th Biennial Congress, to be held at the Hilton Hotel in the Disney World Resort in Orlando, Florida, May 1-3, 2003. This is the first WFC Congress to be held in the United States since 1995. Over 1,000 doctors from approximately 30 countries are expected to attend.

The two major themes of the Congress are management of the cervical spine and sports chiropractic.

The outstanding program has 60 lecturers and technique instructors who truly make up a "Who's Who" in chiropractic. The program has been approved for up to 20 hours of CE credits. For full details please see the Congress' Web site at: <http://www.chiroweb.com/wfcorlando2003>.

9. REVISED MEDICARE MANUAL AVAILABLE

ACA's Medicare Solutions Manual is the only chiropractic-specific Medicare resource reviewed for accuracy by the Centers for Medicare and Medicaid Services (CMS). This manual includes a step-by-step guide to billing and collecting, CMS modifiers and codes, an expanded section on documentation and information on P.A.R.T documentation.

To keep you up-to-date with any changes in Medicare, ACA has published the 2003 Medicare Solutions Manual Update, which includes updated sections and corrections regarding the Advance Beneficiary Notice (ABN), the appeals process, and documentation. The updates also include a revised ABN form, as well as an updated list of Part B state carriers and CMS Regional Offices.

Order your Medicare Solutions Manual and receive the 25-page 2003 Medicare Solutions Manual Update for FREE!

ACA Member Price: $39.95; Non-member Price: $69.95. Order Item MSM2002.

Stay Updated! Already have the Medicare Solutions Manual and want to purchase the updates?

ACA Member Price: $19.95; Non-member Price: $29.95. Order Item MSMupdate.

10. PARKER SEMINARS BRINGS TO DALLAS AN "EVENING OF PHILOSOPHY" BY DR. JOHN DEMARTINI

Dr. Demartini is a rare and gifted chiropractor whose span of experience and study encompasses broad scopes of knowledge, philosophy and healing and whose vision is clearly ahead of its time. Hear Dr. Demartini speak at 6:30 pm on Thursday, April 10th at the Seminars in Dallas, TX. And be sure to experience the entire seminar from April 10-13, to be held at the InterContinental Hotel - Dallas. Register today at <http://www.parkerseminars.com> or call 1-888-727-5338. Chiropractors, health and wellness providers, office teams, exhibitors and patients will come together in the spirit of wellness to join Deepak Chopra, M.D., for his keynote address, "The Spirit of Healing" at 11:00 AM April 11th. This is an event you won't want to miss, so book your flight and hotel today. Call Travel for assistance at 1-877-753-4385.

11. CAN'T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com/>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>.

************************ This message is being sent to you as a courtesy by the executive vice president of the American Chiropractic Association. If you wish to be removed from this list, simply send a message to kpark@... <mailto:kpark@...> with a subject of: "REMOVE - EVP Report."

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Posted April 8, 2003

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Posted April 8, 2003

Considering #1 "Managed Care Industry takes..." is it time for and insurance equality and any willing provider bill?

Vern SAboe

ACA EVP Weekly Report

Memorandum

ACA Members, Board of Governors, House of Delegates and Other Interested Parties From: Cuneo Re: ACA EVP Weekly Report Date: April 7, 2003

The following items are covered in this week's report:

1. MANAGED CARE INDUSTRY TAKES ANOTHER ONE ON THE CHIN: ACA LEGAL COUNSEL'S PERSPECTIVE 2. UPDATE ON LAWSUIT AGAINST FEDERAL GOVERNMENT: CMS POLICY ON MANIPULATION BY PHYSICAL THERAPISTS BACK TO THE WAY IT SHOULD BE

3. HEROES OF THE PROFESSION 4. TEXAS CHIROPRACTIC COLLEGE ALSO DESERVES RECOGNITION 5. ERROR IN IOWA 6. ACA CONTINUES ITS SPONSORSHIP OF OLYMPIC GOLD AND SILVER MEDAL WINNER DEREK PARRA 7. EVP ADVISORY COMMITTEE CONFERENCE CALL, PLUS AN AGENDA FOR THE NEXT CALL 8. THE GOVERNMENT GIVETH AND THE GOVERNMENT TAKETH AWAY 9. ACA IS OFFICIAL PARTNER IN NATIONAL PUBLIC HEALTH WEEK: APRIL 7-13 10. OBTAIN SIMPLE, STRAIGHTFORWARD, HIPAA COMPLIANCE HELP 11. CAN'T ACCESS THESE LINKS?

1. MANAGED CARE INDUSTRY TAKES ANOTHER ONE ON THE CHIN: PERSPECTIVE FROM ACA LEGAL COUNSEL

In what may be perceived as a landmark decision, The U.S. Supreme Court has again diminished the scope of the ERISA preemption of state laws. On April 2, 2003, the court, in a unanimous decision in the trial of Kentucky Association of Health Plans, et al. v. , shielded from federal ERISA preemption a Kentucky statute which provides that any "health benefit plan that includes chiropractic benefits shall... permit any licensed chiropractor" willing to meet plan requirements "to serve as a participating chiropractic provider to any person covered by the plan."

This is another in a line of recent court decisions adversely affecting the managed care industry. For years, all health care groups were attempting to pass legislation that weakened the ERISA preemption provisions, without success. The twin powers of the labor unions and business community blocked this from happening. It has been the courts that have effectively addressed the varied problems that have arisen from the federal preemption of state laws designed to protect the public. Mr. Mcs, Esq., and Mr. Tom Daly, Esq., believe that this court decision has significance beyond the Kentucky statute since the court specifically stepped away from its prior broader criteria in determining when a state law will be preempted by ERISA. (That prior criteria was, interestingly enough, established in the Pireno case which involved chiropractic peer review activity). The court instead adopted new criteria that will enable states greater ability to enforce existing laws and establish new laws protecting the public from managed care and insurance company abuse. The bottom line is that it is now more difficult for a managed care company or insurance company to escape the requirements of state law under the ERISA preemption, and patients of chiropractors will have greater choice in the selection of provider. For more information, contact ACA's legal department at (800) 986-4636. We will to continue to dissect this decision and communicate our findings to the state associations.

2. UPDATE ON LAWSUIT AGAINST FEDERAL GOVERNMENT: CMS POLICY ON MANIPULATION BY PHYSICAL THERAPISTS BACK TO THE WAY IT SHOULD BE

In one of the strangest occurrences in our ongoing litigation against HHS, CMS has reinstated the language of Operational Policy Letter #23 which provides that physical therapists may not be reimbursed under Medicare for the physician service of "manual manipulation of the spine to correct a subluxation." OPL #23 was originally revised and issued by HHS as part of the settlement of Count II of our lawsuit. The ACA and its attorney constantly monitor the rules and regulations that impact on chiropractic and through this monitoring, it was noticed that a subtle but harmful change in the agreed upon language in the OPL had been made. The government's lawyers were immediately notified and ACA representatives took immediate steps to inform responsible HHS officials of the apparent distortion of the regulation. Immediately thereafter, our monitoring of the regulation indicated that a change back to the original language had been made. We have, to this date, no information from CMS or their attorneys explaining the incorrect version. What is it they say about eternal vigilance? I suppose that this is just another reason why the profession needs the ACA. The appropriate language for OPL #23 can now be viewed at

<http://cms.hhs.gov/healthplans/opl/opl023.pdf >

3. HEROES OF THE PROFESSION

When discussing the importance of the Trigon lawsuit, we sometimes forget to discuss those doctors and patients who put their reputation on the line by being plaintiffs in the suit. These Virginia doctors in particular have felt the harassment of being a plaintiff, including reviews of their patient files and other documents: Drs. Chirkinian, , Thesier, Willis, Jerry Willis, Ambrose, McClelland, Porter, Stein, Willis, and Yates. The patients are as follows: Sara , Lana Kay Ball, Margaret Byrne, Dalton, Sue Dean, Harvie Lee Franch, Jr., Herman, Linkenhoker, i, Darlene Requizo, Russotto, Gloria , Lynn D. Wagner, Wallace, Whittington, Benis D. Wood, D. Worley, and Dale Duke Yontz.

4. TEXAS CHIROPRACTIC COLLEGE ALSO DESERVES RECOGNITION

I received a diplomatic but rather pointed message from a SACA student who has contributed to the National Chiropractic Legal Action Fund. The student pointed out that there is another chiropractic college in Texas that has also been a strong supporter of our legal action. He suggested that I check the contributions of the Texas Chiropractic College students and administrators and recognize their efforts. He was right.

Combining the contributions of Texas Chiropractic College, its SACA students and administration, the school has contributed $20,398. My apologies to Texas Chiropractic College for my oversight.

5. ERROR IN IOWA

In my report last week, I talked about the success of Dr. F. Dow Bates, delegate to Iowa, in raising $5,200 in cash and pledges for the National Chiropractic Legal Action Fund. I was right in every way except in identifying the event at which the money was raised. I indicated it was the Iowa Chiropractic Society. In fact it was a conference organized by the Iowa Chiropractic Physicians Clinic, a chiropractic IPA whose president, Dr. Ron , has been a strong supporter of the lawsuits. I want to also mention that Dr. Kraus, alternate delegate to Iowa, was also very helpful in this effort. I apologize for this oversight. I will be reporting in a couple of weeks on the Iowa Chiropractic Society. The Society has invited Dr. Daryl D. Wills, ACA President, to update the doctors on the lawsuits.

6. ACA CONTINUES ITS SPONSORSHIP OF OLYMPIC GOLD AND SILVER MEDAL WINNER DEREK PARRA

I am excited to announce that the ACA has extended its sponsorship of Olympic champion and chiropractic advocate Parra for yet another year. I'm sure you recall 's stunning performances at the 2002 Winter Olympics in Salt Lake City, during which he garnered gold and silver medals in speedskating for the United States. will continue to wear ACA's logo proudly on his equipment whenever possible. We were delighted to have speak at our 2002 ACA House of Delegates meeting in Kansas City, MO, last August. Those of you who had the opportunity to hear 's speech know what a fine young man he is, and what an asset he is to the ACA. Parra was recently nominated for the E. Sullivan Award for amateur athletics, and was honored by inclusion in the inaugural run of a series of "Olympian Heroes" trading cards: <http://www.olympianheroes.com/>. According to , "The people who have stood behind me at Big Bear Mountain Water, Home Depot, Nike, USANA, the American Chiropractic Association, continue to do so, and for that, I'm so, so grateful."

7. EVP ADVISORY COMMITTEE CONFERENCE CALL, PLUS AN AGENDA FOR THE NEXT CALL

The monthly call of the committee was held on Thursday, March 20th. The ACA staff vice presidents and legal counsel were joined by representatives from the Rhode Island Chiropractic Association, North Carolina Chiropractic Association, Alabama Chiropractic Association and the Iowa Association. ACA Chairman , DC, also participated on the call.

Jon Hymes, ACA Vice President of Government Relations, briefed the participants on the Medical Liability Reform Legislation and discussed the current threat of physical therapists both nationally and statewide.

Tom Daly talked about planned hearings of the Federal Trade Commission regarding managed care abuses. It is possible that out of these hearings will come an additional expansion of the safe harbor provisions that currently exist which allow groups of doctors to come together.

Our next conference call is scheduled for April 22nd at 1:00 pm. This call will focus on workers' compensation. We are hearing reports from many states that there is a new effort by the employer community to weaken the workers compensation laws for our profession. I will try to have individuals who have fought or are fighting battles to share their experiences on how they have dealt with the problem on the April 22nd call, including those who contracted with outside research companies to review the cost-effectiveness of chiropractic care.

8. THE GOVERNMENT GIVETH AND THE GOVERNMENT TAKETH AWAY

CMS Administrator Tom Scully and the chief Medicare actuary announced last week that the Medicare payment to physicians could be cut by as much as 4.2% next year due to (a) lower GDP than previously forecast and ( an increase in volume and intensity of physician services (more procedures and tests being ordered by physicians). This cut would come in spite of the $54 billion over ten years added to Medicare as part of the recently enacted FY 2003 supplemental appropriations bill. Although previous estimates from the government indicated that physicians could expect increases in Medicare fees in 2004, CMS is now saying that after this year's 1.6% increase the physician fee schedule updates will be negative through at least 2007.

9. ACA IS OFFICIAL PARTNER IN NATIONAL PUBLIC HEALTH WEEK: APRIL 7-13

The ACA and public health officials across the country are using National Public Health Week, April 7-13, to call attention to the prevalence of obesity among Americans. To show its support for this important observance, ACA distributed a news release over the wire on Monday, April 7, titled "American Chiropractic Association Responds to Epidemic of Obesity in the United States." In addition to pledging its support for National Public Health Week, the release included lifestyle and nutrition tips from the ACA. Efforts such as these help to place doctors of chiropractic as health and wellness experts in the eyes of the public. To see ACA's National Public Health Week news release, visit:

http://www.acatoday.com/hot_topics/040703.shtml

10. OBTAIN SIMPLE, STRAIGHTFORWARD, HIPAA COMPLIANCE HELP

ACA now offers two tools to help your practice become HIPAA-compliant. Meet the HIPAA privacy deadline with the HIPAA Made Easy for Chiropractic Practices kit--it includes everything you'll need to implement privacy compliance, including planning, policies and procedures, contracts/forms, training, and more. HIPAA Made Easy comes in a convenient CD-ROM and binder format. Order Item HIPCHI1 (software license for a practice with 1-4 chiropractors.) Member/Non-member Price: $399/$499. Call 1-800-368-3083 to order.

Also available is an educational audiocassette kit of ACA teleconferences that "demystify" HIPAA and address concerns and questions regarding compliance. On the first audiocassette, an expert in compliance, Marc Cohen, Esq., simplifies the administrative aspects of HIPAA with a primary emphasis on medical records privacy. The second audiocassette features Sanches, a senior advisor on HIPAA Privacy in the Office for Civil Rights in the Department of Health and Human Services. She addresses such topics as mandated services, electronic data interchange, coverage and "incident to" uses and disclosures.

Order Item HIPAATK. Member/Non-member Price: $78/$130. Call 1-800-368-3083 to order.

11. CAN'T ACCESS THESE LINKS?

Some of you have been unable to download my PDF links. To view these file types, you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com <http://www.adobe.com/>. If you need further assistance viewing anything referred to in this report, please e-mail me at gcuneo@... <mailto:gcuneo@...>.

************************ This message is being sent to you as a courtesy by the executive vice president of the American Chiropractic Association. If you wish to be removed from this list, simply send a message to kpark@... <mailto:kpark@...> with a subject of: "REMOVE - EVP Report."

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Posted April 8, 2003

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Posted April 8, 2003

Vern,

Does #1 mean that the Chironets of the world must open to other DCs?

DeSiena

On Tue, 8 Apr 2003 15:21:40 -0700 "Vern Saboe DC" <las@...> writes: